Provider Demographics
NPI:1518932995
Name:JONES, HAROLD KIM (DPM)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:KIM
Last Name:JONES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N 200 W
Mailing Address - Street 2:#1
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2001
Mailing Address - Country:US
Mailing Address - Phone:435-789-2062
Mailing Address - Fax:435-789-2063
Practice Address - Street 1:75 N 200 W
Practice Address - Street 2:#1
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2001
Practice Address - Country:US
Practice Address - Phone:435-789-2062
Practice Address - Fax:435-789-2063
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1066250501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTE0214Medicaid
UTE0214Medicaid
UTU30407Medicare UPIN